• adrenal vein sampling
• computed tomography
• primary aldosteronism

BACKGROUND. Primary aldosteronism (PA) is the most common cause of endocrine hypertension. It is pivotal to distinguish bilateral idiopathic hyperaldosteronism (IHA) from aldosterone-producing adenoma (APA) because surgical removal of the latter can effectively treat PA. Current international guidelines consider adrenal venous sampling (AVS) as the gold standard for diagnosing APA. Pre-test adequate imaging reconstruction of adrenal vein drainage by computed tomography (CT) angiography can improve AVS success.
We aimed to evaluate the AVS performance comparing the selectivity Index of patients who underwent pre-test Angio-CT versus a traditional AVS approach with basal CT.

MATERIALS AND METHODS. This was a retrospective observational study. We included all patients who underwent AVS in the Department of Internal Medicine at Pisa University Hospital between January 2010 and February 2020. We reviewed the medical records to obtain information regarding clinical characteristics, laboratory findings for the case detection and diagnosis of PA, computed imaging scans, AVS results and surgical data. Successful AVS was defined as an adrenal vein to inferior vena cava cortisol ratio >2 (selectivity index).

RESULTS We collected data of 124 AVS and analyzed complete records of 97 patients (59 males and 38 females, median age 48.3 yrs): 37.1% (36/97) executed pre-test Angio CT scan and 62.8% (61/97) only basal CT. Right AVS failed in 53.6% (52/97) of cases with pre-test angioCT in 32% (17/52, P=0.3 NS). Likewise, left AVS failed in 10.3 % (11/97) of cases with pre-test angioCT in 54% (6/11, P=0.2 NS);

CONCLUSIONS: The difficulty of recognizing or cannulating the right adrenal vein is the most frequent cause of AVS failure, due to small length and/or anatomic variations. The pre-test Angio-CT allows an accurate reconstruction of the right adrenal vein before AVS and may help to improve the success rate of the invasive procedure.